Analysis of the quality of e-Consultations in chronic obstructive pulmonary disease.

INTRODUCTION: The quality of e-Consultations in the COPD is unknown. The objectives of this study were (i) to evaluate the quality of referrals; (ii) to define the characteristics of patients referred from Primary Care (PC) to the Unit of Pulmonology; and (iii) to describe differences between accepted and rejected patients. METHODS: A retrospective, observational study of e-Consultations requested by PC for suspected COPD throughout 2022. To quantify the quality of the e-Consultations, an arbitrary scale of 12 variables (score 0-10) was created. RESULTS: In total, 384 e-Consultations were reviewed, of which 167 (43.5 %) resulted in a face-to-face visit, and 217 (56.5 %) were rejected. No differences were observed between the two types of patients, except for confirmations of diagnostic suspicion of COPD [significantly higher in accepted patients (p = 0.042)]; physical examination data of rejected patients (more data provided; p = 0.015); and lung function (significantly better in rejected patients). The mean quality of referrals was acceptable (5.6 ± 2.1 score): 121 (31.3 %) had insufficient quality; 118 (30.5 %) acceptable; 75 (19.4 %) good, and 30 (7.8 %) excellent. Quality was low in half of the variables analyzed (6/12); acceptable in 3, and good in another 3. The capacity of resolution of referrals was good (one e-Consultation) in 199 requests (66.1 %); deficient (two e-Consultations) in 72 (23.9 %), and poor (≥3 e-Consultations) in 30 (10 %). Overdiagnosis was 40.2 % (86/214 e-Consultations). The risk could be classified in 247 patients (64.3 %; 135 low-risk; 90 high-risk). CONCLUSIONS: When adequate information is provided, e-Consultations help identify different levels of severity. However, the quality and capacity of resolution of referrals were suboptimal, with a high percentage of overdiagnoses.

Queratoconjuntivitis por fenilefrina confirmada con pruebas alérgicas tras una exploración ordinaria / Phenylephrine keratoconjunctivitis confirmed by allergy testing after routine examination

Las reacciones alérgicas tras el uso de colirios oftálmicos son comunes y pueden manifestarse con queratoconjuntivitis y dermatitis periorbitaria. La introducción reciente de nuevos fármacos tópicos facilita la sospecha clínica, pero en ocasiones se trata de un uso simultáneo de varios medicamentos y la identificación del alérgeno específico se convierte en un reto. Debido a ello, en muchas ocasiones el diagnóstico es de exclusión, ya que no se llega a confirmar con estudio alergológico el agente desencadenante de la reacción. Tal es el caso de la alergia ocular a fenilefrina, dado que son pocos los cuadros clínicos descritos en la literatura donde hay una clara causa inmunológica. Presentamos un caso poco frecuente, una forma grave de queratoconjuntivitis alérgica tras un examen oftalmológico ordinario confirmada tras estudio alergológico completo

Allergic reactions after using ophthalmic eye drops are very common and frequently manifested by ketaconjuntivitis and periorbital dermatitis. Previous introduction of new topical drugs makes the clinical suspicion easier but sometimes the patient uses multiple medications simultaneously and the specific allergen identification become a challenge. That is the reason why in many occasions the diagnosis is of exclusion since the agent triggering the reaction is not confirmed with an allergologic study. Such is the case of ocular allergy to phenylephrine: there are few clinical cases where there is a clear immunologic cause. We report an uncommon case of a patient who develops a severe form of allergic keratoconjuntivitis after routine ophthalmological examination confirmed by complete allergologic study

Impacts of discarded coffee waste on human and environmental health.

Coffee is one of the most widely consumed beverages throughout the world. So far, many studies have shown the properties of coffee beverages, but little is known about its impacts on human and environmental health from its discard in the environment. So, the present work aims to investigate the mutagenic, genotoxic, cytotoxic and ecotoxic effects of leached (LE) and solubilized (SE) extracts from coffee waste, simulating the disposal of this residue in landfills and via sewage systems, respectively. Chemical analyses were also carried out. LE and SE induced mutagenicity in the TA98 Salmonella strain with and without exogenous metabolization (S9). In the TA100 only SE induced mutagenicity, what was observed without S9. An increase in the frequency of micronuclei was observed in HepG2 cell line after 3 and 24h of exposure to both extracts. No cytotoxic effects were observed in HepG2 cells by WST-1 assay. The EC50 values for the LE and SE were 1.5% and 11.26% for Daphnia similis, 0.12% and 1.39% for Ceriodaphnia dubia and 6.0% and 5.5% for Vibrio fischeri, respectively. Caffeine and several transition metals were found in both extracts. Coffee waste discarded in the environment may pose a risk to human and environmental health, since this compound can cause DNA damage and present toxicity to aquatic organisms.

Dopaminergic involvement during mental fatigue in health and cocaine addiction.

Dopamine modulates executive function, including sustaining cognitive control during mental fatigue. Using event-related functional magnetic resonance imaging (fMRI) during the color-word Stroop task, we aimed to model mental fatigue with repeated task exposures in 33 cocaine abusers and 20 healthy controls. During such mental fatigue (indicated by increased errors, and decreased post-error slowing and dorsal anterior cingulate response to error as a function of time-on-task), healthy individuals showed increased activity in the dopaminergic midbrain to error. Cocaine abusers, characterized by disrupted dopamine neurotransmission, showed an opposite pattern of response. This midbrain fMRI activity with repetition was further correlated with objective indices of endogenous motivation in all subjects: a state measure (task reaction time) and a trait measure (dopamine D2 receptor availability in caudate, as revealed by positron emission tomography data collected in a subset of this sample, which directly points to a contribution of dopamine to these results). In a second sample of 14 cocaine abusers and 15 controls, administration of an indirect dopamine agonist, methylphenidate, reversed these midbrain responses in both groups, possibly indicating normalization of response in cocaine abusers because of restoration of dopamine signaling but degradation of response in healthy controls owing to excessive dopamine signaling. Together, these multimodal imaging findings suggest a novel involvement of the dopaminergic midbrain in sustaining motivation during fatigue. This region might provide a useful target for strengthening self-control and/or endogenous motivation in addiction.